Letter from the American Psychiatric Association to the Finnish Parliament

Jack Drescher

The Chair of the American Psychiatric Association's (APA) Committee on
Gay, Lesbian and Bisexual Issues, psychoanalyst Jack Drescher, sent the
following letter to all Finnish Members of Parliament in September 2001
through the web magazine FinnQueer to inform about the APA's stand on
civil unions for same-gender people.

* * *

September 23, 2001

Dear Dr. Stålström,

I am chair of the American Psychiatric Association's (APA) Committee
on
Gay, Lesbian and Bisexual Issues. I am responding to your letter
requesting (I) information about the APA's positions on homosexuality
and (II) the APA's position regarding a recent study done by Robert
Spitzer, M.D. that was presented at the APA meeting in May of 2001.

(Ia) American Psychiatric Association's 1973 Position on Homosexuality

In 1973, the APA removed homosexuality from its list of mental
disorders (Bayer, 1981). While it is true that protests by
gay rights activists
provided the impetus to reevaluate the
APA's earlier position, it is not
correct that the final
decision was based on political considerations. The
reevaluation was done by a scientific committee of the APA which
was
chaired by Robert Spitzer, M.D. The committee looked at
early
psychoanalytic claims that homosexuality was an illness
(i.e., Rado, 1940;
Bieber et al, 1962, Socarides, 1968) and
weighed them against studies that
argued that homosexuality was not
an illness (i.e., Kinsey et al, 1948,
1953; Ford and Beach, 1951;
Hooker, 1957; Marmor, 1965). It was the
weighing of the scientific
evidence, and not political pressure that led
to the APA's decision to
remove homosexuality from the diagnostic manual.

It should be noted that the psychoanalytic practitioners of
that era who
disagreed with the APA's decision have
themselves politicized the
discussion. For example, after the
scientific committee made its
decision, those who disagreed
with it called for a membership vote on the
issue. A petition
to force the APA referendum -- a political vote on a
scientific
decision--was forged and signed by 200 people at a meeting of
the
American Psychoanalytic Association (Bayer, 1981). After they lost
the vote, some have presented a distorted history of those events.
For
example, in addition to false claims that the change was
entirely
political, Socarides (1995) has even accused the APA of
miscounting the
referendum votes.

(Ib) Recent Positions of the American Psychiatric Association

Because it no longer considers homosexuality to be an illness, the APA's
current positions reflect its belief that homosexuality is a normal
variant of human sexuality. Therefore, since the 1973 decision, APA has
issued many statements in support of gay and lesbian civil rights.

Among the most recent is a 1998 statement regarding so-called reparative
therapies. It states that "the American Psychiatric Association opposes
any psychiatric treatment, such as 'reparative' or 'conversion' therapy
which is based upon the assumption that homosexuality per se is a mental
disorder or based upon the a priori assumption that the patient should
change his/her sexual homosexual orientation" (APA, 1998; See Appendix 1
for full statement).

In 2000, the APA went even further. It's Commission on Psychotherapy by
Psychiatrists issued a statement, approved by the entire APA leadership,
that made the following recommendations:

1. APA affirms its 1973 position that homosexuality per se is not a
diagnosable mental disorder. Recent publicized efforts to
repathologize homosexuality by claiming that it can be cured are often
guided not by rigorous scientific or psychiatric research, but
sometimes by religious and political forces opposed to a full civil
rights for gay men and lesbians. APA recommends that the APA respond
quickly and appropriately as a scientific organization when claims that
homosexuality is a curable illness are made by political or religious
groups.

2. As a general principle, a therapist should not determine the goal of
treatment either coercively or through subtle influence.
Psychotherapeutic modalities to convert or "repair" homosexuality are
based on developmental theories whose scientific validity is
questionable. Furthermore, anecdotal reports of "cures" are
counterbalanced by anecdotal claims of psychological harm. In the last
four decades, "reparative" therapists have not produced any rigorous
scientific research to substantiate their claims of cure. Until there
is such research available, APA recommends that ethical practitioners
refrain from attempts to change individuals' sexual orientation, keeping
in mind the medical dictum to first, do no harm. (See Appendix 2 for
full statement).

In specific regard to the issue of civil unions, in 2000, the APA's
Board of Trustees voted to affirm that "The American Psychiatric
Association supports the legal recognition of same sex unions and their
associated legal rights, benefits, and responsibilities" (See Appendix 3
for full statement).

(II) The Spitzer Study

In May of 2001, the APA held its annual meeting in New Orleans. A
symposium at that meeting addressed "Clinical Issues and Ethical
Concerns Regarding Attempts to Change Sexual Orientation: An Update."
The symposium was sponsored by the Association of Gay and Lesbian
Psychiatrists and Dr. Spitzer was invited to present his unpublished
findings. As you know, before the Spitzer study was even presented at
the meeting, the press picked it up and proceeded to blow its actual
research importance out of proportion.

For the record, a presentation of any study at a meeting of the APA
does not mean that the APA endorses the study. The APA meeting
provides a forum for the exchange of ideas, even those whose scientific
validity have yet to be proven. In other words, the presentation of a
study at one of APA's meetings does not carry the same scientific
weight as having the study published in a peer-
reviewed journal. To
date, the study has not been published in a peer-reviewed journal.

As for the scientific merits of his study, I believe it is significantly
flawed. One flaw is that the majority of subjects in the study had one
45-minute telephone interview with Dr. Spitzer and no follow-ups. Other
than Dr. Spitzer, I can find no reputable researcher who will agree that
this is an accurate way to assess whether a person has changed their
sexuality. That point was underscored in another study presented at the
same symposium. Schroeder and Shidlo's study (in press) found that many
individuals who claimed to have changed sexual orientation during a
first telephone interview changed their story at a second, follow-up
interview.

I know Dr. Spitzer plans to respond to you himself and I am confident he
will make his own thoughts clear about the misuse of his study by
political and religious groups opposed to gay and lesbian civil rights.
Despite our differing interpretations of his study, both Dr. Spitzer and
myself are of the opinion that there is a small group of people whose
sexual orientation can change, sometimes even without any therapy. But
neither of us believe that everyone's sexual orientation can change. To
claim that everyone can change or that everyone should change is simply
not true. To scientifically argue for that position in opposition to
gay and lesbian civil rights is not only a misuse of Dr. Spitzer's study
but a travesty of science itself.

If I can be of any further assistance, please do not hesitate to contact
me.

Appendix 1

American Psychiatric Association Position Statement on Psychiatric
Treatment and Sexual Orientation

December 11, 1998

The Board of Trustees of the American Psychiatric Association removed
homosexuality from the DSM in 1973 after reviewing evidence that is was
not a mental disorder. In 1987, ego-dystonic homosexuality was not
included in the DSM-III-R after a similar review.

The American Psychiatric Association does not currently have a formal
position statement on treatments that attempt to change a person's
sexual orientation, also known as "reparative or conversion therapy."
There is an APA 1997 Fact Sheet on Homosexual and Bisexual Issues, which
states that "there is no published scientific evidence supporting the
efficacy of "reparative therapy" as a treatment to change one's sexual
orientation."

The potential risks of "reparative therapy" are great, including
depression, anxiety and self-destructive behavior, since therapist
alignment with societal prejudices against homosexuality may reinforce
self-hatred already experienced by the patient. Many patients who have
undergone "reparative therapy" relate that they were inaccurately told
that homosexuals are lonely, unhappy individuals who never achieve
acceptance or satisfaction. The possibility that the person might
achieve happiness and satisfying interpersonal relationships as a gay
man or lesbian is not presented, nor are alternative approaches to
dealing the effects of societal stigmatization discussed. The APA
recognizes that in the course of ongoing psychiatric treatment there may
be appropriate clinical indications for attempting to change sexual
behaviors.

Several major professional organizations including the American
Psychological Association, the National Association of Social Workers
and the American Academy of Pediatrics have all made statements against
"reparative therapy" because of concerns for the harm caused to
patients. The American Psychiatric Association has already taken clear
stands against discrimination, prejudice and unethical treatment on a
variety of issues including discrimination on the basis of sexual
orientation.

Therefore, the American Psychiatric Association opposes any
psychiatric treatment, such as "reparative" or "conversion" therapy
which is based upon the assumption that homosexuality per se is a mental
disorder or based upon the a priori assumption that the patient should
change his/her sexual homosexual orientation.

Appendix 2

American Psychiatric Association
Commission on Psychotherapy by Psychiatrists (COPP)
Position Statement on Therapies Focused on Attempts to Change Sexual
Orientation (Reparative or Conversion Therapies)

Preamble
In December of 1998, the Board of Trustees issued a position
statement that the American Psychiatric Association opposes any
psychiatric treatment, such as "reparative" or conversion therapy,
which is based upon the assumption that homosexuality per se is a
mental disorder or based upon the a priori assumption that a patient
should change his/her sexual homosexual orientation (Appendix 1). In
doing so, the APA joined many other professional organizations that
either oppose or are critical of "reparative" therapies, including the
American Academy of Pediatrics, the American Medical Association, the
American Psychological Association, The American Counseling
Association, and the National Association of Social Workers (1).

The following Position Statement expands and elaborates upon the
statement issued by the Board of Trustees in order to further address
public and professional concerns about therapies designed to change a
patient's sexual orientation or sexual identity. It augments rather
than replaces the 1998 statement.

Position Statement
In the past, defining homosexuality as an illness
buttressed society's moral opprobrium of same-sex relationships (2).
In the current social climate, claiming homosexuality is a mental
disorder stems from efforts to discredit the growing social acceptance
of homosexuality as a normal variant of human sexuality. Consequently,
the issue of changing sexual orientation has become highly politicized.
The integration of gays and lesbians into the mainstream of American
society is opposed by those who fear that such an integration is
morally wrong and harmful to the social fabric. The political and
moral debates surrounding this issue have obscured the scientific data
by calling into question the motives and even the character of
individuals on both sides of the issue. This document attempts to shed
some light on this heated issue.

The validity, efficacy and ethics of clinical attempts to change an
individual's sexual orientation have been challenged (3,4,5,6). To
date, there are no scientifically rigorous outcome studies to determine
either the actual efficacy or harm of reparative treatments. There is
sparse scientific data about selection criteria, risks versus benefits
of the treatment, and long-term outcomes of reparative therapies. The
literature consists of anecdotal reports of individuals who have
claimed to change, people who claim that attempts to change were
harmful to them, and others who claimed to have changed and then later
recanted those claims (7,8,9).

With little data about patients, it is possible to evaluate the
theories which rationalize the conduct of "reparative" or conversion
therapies. Firstly, they are at odds with the scientific position of
the American Psychiatric Association which has maintained, since 1973,
that homosexuality per se, is not a mental disorder. The theories of
"reparative" therapists define homosexuality as either a developmental
arrest, a severe form of psychopathology, or some combination of both
(10-15). In recent years, noted practitioners of "reparative therapy"
have openly integrated older psychoanalytic theories that pathologize
homosexuality with traditional religious beliefs condemning
homosexuality (16,17,18).

The earliest scientific criticisms of the early theories and religious
beliefs informing "reparative" or conversion therapies came primarily
from sexology researchers (19-27). Later, criticisms emerged from
psychoanalytic sources as well (28-39). There has also been an
increasing body of religious thought arguing against traditional,
biblical interpretations that condemn homosexuality and which underlie
religious types of "reparative" therapy (40-46).

Recommendations

1. APA affirms its 1973 position that homosexuality per se is not a
diagnosable mental disorder. Recent publicized efforts to
repathologize homosexuality by claiming that it can be cured are often
guided not by rigorous scientific or psychiatric research, but
sometimes by religious and political forces opposed to a full civil
rights for gay men and lesbians. APA recommends that the APA respond
quickly and appropriately as a scientific organization when claims that
homosexuality is a curable illness are made by political or religious
groups.

2. As a general principle, a therapist should not determine the goal of
treatment either coercively or through subtle influence.
Psychotherapeutic modalities to convert or "repair" homosexuality are
based on developmental theories whose scientific validity is
questionable. Furthermore, anecdotal reports of "cures" are
counterbalanced by anecdotal claims of psychological harm. In the last
four decades, "reparative" therapists have not produced any rigorous
scientific research to substantiate their claims of cure. Until there
is such research available, APA recommends that ethical practitioners
refrain from attempts to change individuals' sexual orientation,
keeping in mind the medical dictum to First, do no harm.

3. The "reparative" therapy literature uses theories that make it
difficult to formulate scientific selection criteria for their
treatment modality. This literature not only ignores the impact of
social stigma in motivating efforts to cure homosexuality, it is a
literature that actively stigmatizes homosexuality as well.
"Reparative" therapy literature also tends to overstate the
treatment's accomplishments while neglecting any potential risks to
patients.
APA encourages and supports research in the NIMH and the
academic research community to further determine "reparative" therapy's
risks versus its benefits.

References

(1) National Association for Research and Treatment of Homosexuality,
(1999), American Counseling Association Passes Resolution to Oppose
Reparative Therapy. NARTH Website
(http://www.narth.com/docs/acaresolution.html).

(2) Bayer, R. (1981), Homosexuality and American Psychiatry; The
Politics of Diagnosis. New York: Basic Books.

(45) Gomes, P. J. (1996). The Good Book: Reading the Bible with Mind
and Heart. New York: Avon.

(46) Carrol, W. (1997), On being gay and an American Baptist minister.
The InSpiriter, Spring, pp. 6-7,11.

Appendix 3

American Psychiatric Association
Position Statement on Same Sex Unions
Approved December 2000 by the APA Board of Trustees

The APA expresses a valid interest in the well being of heterosexual
married couples in such areas as children's mental health and other
aspects of family life. Heterosexual relationships have a legal
framework for their existence, which provides a stabilizing force.

In the United States, with the recent exception of Vermont, same sex
partners are currently denied the important benefits and
responsibilities of legal marriage. Same sex couples therefore
experience several kinds of state-
sanctioned discrimination that
affect the stability of their relationships.

The children of gay and lesbian parents do not have the same protection
that legal marriage affords the children of heterosexual couples.
Adoptive and divorced lesbian and gay parents face additional
obstacles. An adoptive parent who is lesbian or gay is presumed unfit
in many U.S. jurisdictions. Furthermore, when couples do adopt,
usually one parent is granted legal rights, while the other parent may
have no legal standing. These obstacles occur even though research has
shown that the children raised by lesbian and gay men are as well
adjusted as those reared within heterosexual relationships.

The American Psychiatric Association has historically supported equity,
parity, and non-discrimination regarding legal issues affecting mental
health. Educating the public about lesbian and gay relationships and
supporting efforts to establish same sex legal unions is consistent
with the Association's advocacy for other disadvantaged minority
groups.

"The American Psychiatric Association supports the legal recognition of
same sex unions and their associated legal rights, benefits, and
responsibilities".